Risk communication during treatment decision-making conversations with older people with advanced kidney disease

Area of Science:

• Nephrology
• Geriatrics
• Medical Communication

Background:

• Most older adults with advanced kidney disease face limited treatment options: dialysis or conservative kidney management (CKM).
• Existing research suggests a bias towards discussing dialysis over CKM in clinical settings.
• Dialysis may not always offer superior benefits for elderly patients or those with comorbidities.

Purpose of the Study:

• To investigate how risks and benefits of dialysis versus CKM are communicated in consultations.
• To identify communication strategies that position CKM as a viable treatment choice for older adults with advanced kidney disease.

Main Methods:

• Analysis of 30 recorded outpatient consultations in UK renal units involving patients aged 65+ with Chronic Kidney Disease.
• Conversations focused on decisions between dialysis and CKM, involving doctors and nurses.
• Utilized conversation analysis to examine communication patterns.

Main Results:

• Conservative kidney management (CKM) was perceived as a valid option by patients when the risks, burdens, and limited benefits of dialysis were clearly communicated.
• Effective communication included discussing dialysis's impact on quality of life.
• Conveying uncertainty about dialysis's survival benefits and personalizing risk information were crucial.

Conclusions:

• Clinician communication strategies can significantly influence patient perception of CKM as a valid treatment option.
• Framing dialysis risks and uncertainties empowers patients to consider CKM alongside dialysis.
• This approach supports shared decision-making for advanced kidney disease management in older adults.